A RT I C L E A N A LY S I S & E VA LUAT I O N Headaches may be associated with temporomandibular pain Original Article:
Ciancaglini R, Radaelli G. The relationship between headache and symptoms of temporomandibular disorder in general population. J Dent 2001;29:93-8.
• Level of Evidence: • Purpose:
• Source of Funding: • Type of Study/Design:
To determine whether there is an association between headache and symptoms of temporomandibular disorder in a general adult population
A total of 483 subjects (300 females, 183 males) in the municipality of Segrate, a metropolitan area in northern Italy, were studied. These subjects were chosen from 520 families randomly selected from a census list and were part of an epidemiologic survey conducted in 1995 to determine oral health and treatment needs. The participation rate was 84%.
The exposure was temporomandibular pain.
MAIN OUTCOME MEASURE The main outcome measure was headaches. MAIN RESULTS The prevalence of headache was 21.2%. The prevalence of temporomandibular symptoms
was 54.3%. Headache occurred significantly more in subjects with temporomandibular pain. After adjustment for confounding variables, individuals with temporomandibular pain had 83% increased odds for reporting headaches than individuals without temporomandibular pain (odds ratio 1.83; 95% confidence interval, 1.073.15; Table 3).
J Evid Base Dent Pract 2001;1:196-7 Copyright © 2001 by Mosby, Inc doi:10.1067/med.2001.120210
COMMENT ARY CONCLUSIONS In the general adult population, there is an association between headache and symptoms of temporomandibular disorder (TMD).
ANALYSIS The primary value of this study is to bring the clinicians attention to explore the possibility of TMD in patients with unexplained headache. Results seemed to indicate an association, however, the reader needs to consider the internal and external validity of the results to assess the meaning of these results for daily practice. First of all, the information was gathered entirely by an interview survey that was
not specifically designed to assess the exposure and outcome measures mentioned earlier (ie, headache and TMD). Although questions regarding headache and TMD were included, there is no evidence that the survey was validated prior to the study. In addition, the survey is cross-sectional, obtaining information at only one point in time rather than longitudinally and is based on retrospective reporting. This can result in biases due to variance in ability to recollect and describe symptoms experienced. Overall, the approach to analysis was appropriate, and the authors make appropriate comments regarding the limitations of the subject with regard to the cross-sectional design.
Table 3. Results from a multiple logistic regression model fitted for headache with symptoms of TMD as independent variables (* statistical significance) Also adjusted for confounding variablesa
Adjusted for other symptoms Symptom
Odds ratiob 95% confidence interval
Temporomandibular joint sounds Feeling of stiffness or fatigue of the jaws Difficulty in opening the mouth wide or in locking the mouth Luxation Pain on movements of the jaw Temporomandibular pain Pain in other facial sites
Odds ratiob 95% confidence interval
1.58 0.87 1.16
(0.80-3.13) (0.65-1.16) (0.54-2.49)
.188 .346 .712
1.57 0.71 1.15
(0.79-3.14) (0.33-1.55) (0.53-2.50)
.199 .396 .725
1.07 1.67 1.94 1.23
(0.93-1.23) (0.68-4.09) (1.20-3.13) (0.45-3.37)
.337 .259 .007* .687
1.07 1.76 1.83 1.16
(0.84-1.37) (0.75-4.15) (1.07-3.15) (0.68-2.40)
.563 .193 .028* .689
sex, loss of occlusal support (yes/no), and neck pain (yes/no). category: no. (Reprinted from Ciancaglini R, Radaelli G. J Dent 2001;29:93-8. By permission.)
• Content Reviewer: • Biostatistical/Epidemiology Reviewer:
Journal of Evidence-Based Dental Practice Volume 1, Number 3
Jean Suvan, RDH, CRA, Eastman Dental Institute, London, England Robert J.Weyant, DMD, DrPH, University of Pittsburgh, Pennsylvania
Ciancaglini and Radaelli 197